Medical Reform

[Sabremech]

6 hours ago, Marauder said:

And, oh, how is my cowl coming along

You might be next! 

[midlifeflyer]

5 hours ago, Cruiser said:

It baffles me why there are so many complaints about BasicMed. 

BasicMed is a huge step forward for many GA pilots that will benefit greatly. Others, not so much. 

Maybe some physicians will not participate but many others will. Does it really matter?

The result is we have one more option available that gives us greater control in decision making, reduces bureaucracy and eliminates the fear of denial from a faceless FAA in Oklahoma City.

Simple. We live in a time where anything that is not 100% "what I want"  is, by definition, horrible. No solution is better than a partial solution. We take each shortcoming and blow it out of proportion, and imagine others that may not even exist. We do it with EVERYTHING. Why not with BasicMed?

[midlifeflyer]

25 minutes ago, bluehighwayflyer said:

We must view the purpose of of the flight physical differently. To me it's purpose is to insure that I am physically able to safely operate an aircraft and that I have a reasonable likelihood of not keeling over at the controls.  What does either my prostate (or as Chris has pointed out my anus) have to do with that? 

That having been said, BasicMed does seem like an improvement to me. Family practitioners are asked to fill out work-related certification forms such as this all of the time. There is nothing unique about this as far as liability fears go IMHO.

 

...and, like DOT, occupational return to work, and other similar certifications, if PCPs are unwilling, a cottage industry will grow to fill the void.

Of course there's some liability associated with saying "you are good to go," but I agree there is probably nothing unique about it. Every cardiologist who okays a patient going back to work after a heart attack probably assumes a significantly higher risk.

Anyone here who actually knows (not believes) something about medical malpractice (it's a field I never even dabbled in)? I would not be at all surprised to learn the type of occupational certification we are talking about with BasicMed are among the lowest in real liability risk of medical activities.

[Danb]

A buddy who flies Brand B, has been waiting to get going, had his physical last week, the Doc is filling out the paper work today, seemed like no problem, totally surprised me.

[peevee]

26 minutes ago, midlifeflyer said:

...and, like DOT, occupational return to work, and other similar certifications, if PCPs are unwilling, a cottage industry will grow to fill the void.

Of course there's some liability associated with saying "you are good to go," but I agree there is probably nothing unique about it. Every cardiologist who okays a patient going back to work after a heart attack probably assumes a significantly higher risk.

Anyone here who actually knows (not believes) something about medical malpractice (it's a field I never even dabbled in)? I would not be at all surprised to learn the type of occupational certification we are talking about with BasicMed are among the lowest in real liability risk of medical activities.

I would think the case could be made that yeah, he/she was good to go the date and time I saw the person. Whatever happened 5 minutes later how are they to know?

 

is it ideal? no. Is it better than what we had before? yes.

[DonMuncy]

1 hour ago, midlifeflyer said:

Of course there's some liability associated with saying "you are good to go," but I agree there is probably nothing unique about it. Every cardiologist who okays a patient going back to work after a heart attack probably assumes a significantly higher risk.

My belief is that many non pilots view flying as a high-skill, overly dangerous, activity. Some may OK you for "ordinary" work, but be extremely afraid to take on the liability for your death-defying activity. That being said, a bunch more may have no problem at all. If one decides to go Basic Med, I think it might be wise to ask their primary care physicians to see what their attitude is before using them for that purpose. It would be a shame, to have to change primary care doctors, just to get your sign-off, but in some cases it might be a prudent thing.

[Sabremech]

Hate it or like it, we now have two choices where we had one before. Personally I like it and think I'll get a better physical than the old turn your head and cough that I had been getting. 

[southernIL]

BasicMed is a basic bust for me. I need a renewal third class or go the basicmed route. I contacted seven doctors in my area, two of them fly, two of them do third class physicals, and three are general practitioners. The three GPs new nothing about it and don't want to know anything about it. The other four knew about basicmed but all seven said the same thing - they are not going to add it to their liability insurance because the cost will be more than any income from it. Monday I get a third class medical, fast, easy, no online BS hassle.

[Tom]

AMEs are not affiliated with the FAA any more than a pilot is affiliated with the FAA.  Both are given certification by the FAA.

The AME has basically no liability because the AME is NOT making a medical decision and is NOT making a determination of health and safety.   

The AME is only saying that the information on the airman's MedXPress application does not conflict with FAA rules.  That's basically it.  Glorified cross-reference technician with tax write-off privileges. 

The BasicMed physician certification is completely different. 

The physician signing off a BasicMed applicant is saying that applicant's medical history does not contain any information that is in conflict with the entire body of aeromedical scientific literature (i.e. that which will be called upon in a lawsuit), or at least customary practice in the field of aviation medicine.

Moreover, if/when the physician signing off the BasicMed application has a relationship with said patient-pilot, an entirely different customary due diligence expectation exists for medical decision-making. 

The AME has, relatively speaking, no due diligence responsibility except as required by FAA.

----

Points to ponder for people who think that BasicMed is a reasonable step forward:

Do you really think that an AME is going to sign off a condition under BasicMed that would require a SI for a 3rd Class? 

Do you really think that s/he will sign a form that says "I certify that I am not aware of any medical condition that, as presently treated, could interfere with the individual's ability to safely operate an aircraft" when s/he knows, based on more broad aeromedical training and experience, that there is scientific literature demonstrating a safety issue (that the FAA allows but that nonetheless is known to interfere with an individual’s ability to operate an aircraft)?

Do you think that your AME is going to accept going from no liability with giving 3rd classes to signing a form that admits ignoring the science and customary aviation medical practices?

Do you realize how easy it will be to hang a family doc out to dry after a certified BasicMed pilot has an accident?

----

Chiropractors, naturopathic physicians, optometrists, dentists, and MD/DOs all can sign off on BasicMed.  We'll see how long this lasts...I say chiropractors will last the longest.

This is a far cry from "just need a valid driver's license" and I'm afraid it's only to get further away as time goes on.

[AndyFromCB]

On 1/29/2017 at 4:04 PM, Tom said:

There in no comparing the liability exposure of sports, scout, scuba, and summer camp physicals to the BasicMed physical.

Most pilots know at least one, if not several, other pilots who have died in small plane crashes.  In my medical career I can't recall ever meeting anyone who has ever met someone who has known a child who died playing sports from a heart condition, or during scouts, summer camp, nor any adult who has died while scuba diving.

To ambulance chasers, every accident is an opportunity to fleece someone, pure and simple.  Every aviation accident where the pilot is killed is grounds for a suit.  Dead men tell no tales, so if Mr. Pilot augers in for absolutely any reason and the autopsy finds that Mr. Pilot had heart disease (which is almost the norm after age 40-50), it will be obvious to the attorney that Mr. Pilot was incapacitated by his heart condition and crashed as a result.  In all reality, such cases will settle out of court.  

Many people do not understand that after accidents many medical lawsuits occur in effort to help the survivors pay for medical costs associated with the accident (i.e. the survivors wouldn't normally sue, but if there are grounds to get money to pay the medical bills, they might pursue a suit).  This is one of the negative consequences of having a a system where we have neither a ~socialized healthcare system nor a system that requires people to carry the insurance coverage required to pay for care if/when injured.

It has not been mentioned here that dentists, chiropractors, and naturopathic physicians all will be able to sign off on BasicMed (if they are a state licensed physician).  With all due respect to my colleagues in healthcare, for certain you can always find someone in one of the more "bankruptcy prone" fields to sign off on anything.

I don't agree with a "time will tell" approach to BasicMed.  AOPA/EAA should get hot on getting rid of this "physician certification" issue before the cement really hardens.

Really? A chiropractor can now sign off on a medical? Someone must have been suffering from cranial subluxation at the FAA. On the other hand, I see a business opportunity here. 

Edited April 26, 2017 by AndyFromCB

[Sabremech]

3 hours ago, Tom said:

AMEs are not affiliated with the FAA any more than a pilot is affiliated with the FAA.  Both are given certification by the FAA.

 

The AME has basically no liability because the AME is NOT making a medical decision and is NOT making a determination of health and safety.   

 

The AME is only saying that the information on the airman's MedXPress application does not conflict with FAA rules.  That's basically it.  Glorified cross-reference technician with tax write-off privileges. 

 

The BasicMed physician certification is completely different. 

 

The physician signing off a BasicMed applicant is saying that applicant's medical history does not contain any information that is in conflict with the entire body of aeromedical scientific literature (i.e. that which will be called upon in a lawsuit), or at least customary practice in the field of aviation medicine.

Moreover, if/when the physician signing off the BasicMed application has a relationship with said patient-pilot, an entirely different customary due diligence expectation exists for medical decision-making. 

 

The AME has, relatively speaking, no due diligence responsibility except as required by FAA.

 

----

 

Points to ponder for people who think that BasicMed is a reasonable step forward:

 

Do you really think that an AME is going to sign off a condition under BasicMed that would require a SI for a 3rd Class? 

 

Do you really think that s/he will sign a form that says "I certify that I am not aware of any medical condition that, as presently treated, could interfere with the individual's ability to safely operate an aircraft" when s/he knows, based on more broad aeromedical training and experience, that there is scientific literature demonstrating a safety issue (that the FAA allows but that nonetheless is known to interfere with an individual’s ability to operate an aircraft)?

 

Do you think that your AME is going to accept going from no liability with giving 3rd classes to signing a form that admits ignoring the science and customary aviation medical practices?

 

Do you realize how easy it will be to hang a family doc out to dry after a certified BasicMed pilot has an accident?

 

----

 

Chiropractors, naturopathic physicians, optometrists, dentists, and MD/DOs all can sign off on BasicMed.  We'll see how long this lasts...I say chiropractors will last the longest.

 

This is a far cry from "just need a valid driver's license" and I'm afraid it's only to get further away as time goes on.

 

Is the liability really any more for a doctor giving a general aviation medical exam say versus a DOT exam? I really doubt it as that semi can slam into a school bus or a van with a family in it. What kind of lawsuit do you think will come out of that? This is more likely than a basicmed pilot crash. My personal physician said he would do it and has no problem with it. He has plenty of higher liabilities over his head than me and my physical. 

I'm in the wait and see how it all plays out camp instead of dreaming up what ifs. 

[Cruiser]

6 hours ago, Tom said:

The physician signing off a BasicMed applicant is saying that applicant's medical history does not contain any information that is in conflict with the entire body of aeromedical scientific literature (i.e. that which will be called upon in a lawsuit), or at least customary practice in the field of aviation medicine.

Tom, I have to strongly disagree with this statement. 

First, the applicant is presenting themselves with a valid FAA medical that had been previously approved.

Second, the only medical history relevant is that which has occurred since that last valid FAA medical

Third, you present a SI condition as a cause for denial when if fact the SI is actually an approval by the FAA Medical headquarters

Fourth, the FAA reserved four key areas of medical health that the BasicMed cannot be issued

and Finally, the examining doctor is only certifying that he completed the examination in accordance with the checklist provided by the FAA and that based on that examination he is not AWARE of any medical condition (existing at the time of the exam) could interfere with the individual's ability to safely operate an aircraft.

[Roger O]

Cruiser, you are 100% correct in your statements.  The liability is no more (possibly less) than doing a regular annual exam.  If you get an exam that checks out ok, get in your car, have a massive coronary and die, is the MD that did the exam liable for damages to you or others?  Hardly.  That is life, and no one but God knows when it will end.

As far as ANY health care practitioner signing off on an exam, that is highly doubtful, and I for one would love to see where it says that.  As a licensed dentist, my state dental practice act only allows me to examine those parts of the body associated with my area of expertise.  Doing a genital exam on a woman has been known to get many a dentist in big trouble! 

[BKlott]

I had my physical exam with my family Doctor (MD) today. He had absolutely no problem with giving me the exam or completing the Checklist form. He was very thorough and completed every item on the form adding his notes and comments to the form itself. We spent a good 45+ minutes together, discussing the program and how it compared to the old way of doing things with an AME. I told him in a very direct manner that there will come a time that I may need to stop flying due to my health or cognitive decline. I told him that he needs to be honest with me and deliver that message when the time comes. Believe me, that is a message that I am not going to want to receive. For this program to work and actually benefit us, I think we need to have that open dialogue with our Doctors. I think we also need to take a more active, knowledgeable role in our health.

After dinner I sat down and completed the on-line course. The course itself, was very well done. It is interesting, not dull and boring. There are plenty of short videos and attractive graphics throughout. There are also links to many other resources for each topic in case you would like additional information. The people who put this together obviously did it in a very thoughtful and professional manner. I learned a few things. The test was straight forward and I passed with a score of 90 on my first attempt.

I printed out my certificate and am now ready to fly under BasicMed effective 5/1/2017!

If you are on the fence about trying BasicMed, you can take the on-line course to see what it is like with no cost or obligation.

In the past, I would never tell an AME about any health concerns that I had. If he asked, my answer was always the same. "I am the picture of health." My attitude was "what he doesn't know won't hurt me." I wanted to fly. He snickered to himself, knowing full well that I was "full of it", but that is how the system worked. Of course, my family Doctor knew better too. He's the one I would be open and honest with. After all, he couldn't ground me.

That is how the old system worked. Everyone knew it and everyone was happy. Thinking back on it now, that was all just plain silly. My family Doctor is the most knowledgeable person with regards to my health. He should be the one to advise me and be part of the decision making process, along with my family, for when my flying days come to an end. I think that is how it should be and that is far more preferable than having some physician in Oklahoma City making that decision for me.

P.S. Yes, my Doctor did complete item #9 on the Checklist, the exam of my "anus". We discussed it and both laughed about it. I did share with him that I have sent an email to the FAA asking them to explain the rationale behind that item. Another Mooneyspace member also was questioning this. I pointed out to the FAA that over the past 34 years since I took my first AME administered exam as a Student Pilot that not one of the four (4) AMEs that have examined me ever once examined my "anus". I can now honestly report without any doubts that mine has now been examined. Apparently I do have one.

 

Edited April 27, 2017 by BKlott

[HRM]

10 hours ago, DonMuncy said:

My belief is that many non pilots view flying as a high-skill, overly dangerous, activity. 

Last night at a banquet there were "conversation starter questions" under the coasters. One dinner looked at hers and asked the table "What's the riskiest thing you have ever done?"

One of my students said, "Dr. Myler, aren't you a SCUBA diver?"

Before I could acknowledge my wife blurts out "That's nothing, he's a pilot!"

[Dave Piehler]

I had my regular visit to my MD today, part of the yearly process of gathering documentation for my Special Issuance (cardiac).  As long as I was at it, I had him complete the BasicMed form.  Then I took the on line course tonight.  Done!

Because I have everything in line to get my Class III reissued for another year under my special issuance I'm going to proceed with it one last time for old time's sake, but after that I have three more years until I need to do the dance again.

Dave Piehler

N4583H

[BKlott]

11 minutes ago, Dave Piehler said:

I had my regular visit to my MD today, part of the yearly process of gathering documentation for my Special Issuance (cardiac).  As long as I was at it, I had him complete the BasicMed form.  Then I took the on line course tonight.  Done!

Because I have everything in line to get my Class III reissued for another year under my special issuance I'm going to proceed with it one last time for old time's sake, but after that I have three more years until I need to do the dance again.

Dave Piehler

N4583H

Why run the risk of a "denial" when you are already good to go under BasicMed? That is why I chose not to renew my Special Issuance which expired March 31, 2017. It wasn't worth the risk for 1 month of flying privileges.

 

[Dave Piehler]

After doing this for 8 years I have it down pat. The risk of denial is de minimis.


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[bradp]

Question for the group ... I'm thinking about doing CSEL followed by CFI. In the revision to the language before passage, flight instruction was included under basic med. If I need to have a commercial certificate for CFI but don't otherwise want to exercise privileges of commercial, can I skip the class II and just do basic med?


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[midlifeflyer]

2 hours ago, bradp said:

Question for the group ... I'm thinking about doing CSEL followed by CFI. In the revision to the language before passage, flight instruction was included under basic med. If I need to have a commercial certificate for CFI but don't otherwise want to exercise privileges of commercial, can I skip the class II and just do basic med?


Sent from my iPhone using Tapatalk

Yes. 

First, as background, you haven't needed anything more than a third class for at least 20 years.

Second, the FAA rule amended that paragraph, 61.23(a)(3)(iii) to read, a third class medical is required...

When taking a practical test in an aircraft for a recreational pilot, private pilot, commercial pilot, or airline transport pilot certificate, or for a flight instructor certificate, except when operating under the conditions and limitations set forth in § 61.113(i); 

That's a reference to the limitations of BasicMed.

[Tom]

17 hours ago, Sabremech said:

My personal physician said he would do it and has no problem with it. He has plenty of higher liabilities over his head than me and my physical. 

I hope that this can be the case forever.  I really do.

17 hours ago, Sabremech said:

I'm in the wait and see how it all plays out camp instead of dreaming up what ifs. 

Do you mean that if you were a physician that you'd start signing off on a bunch of 75 year-old wealthy males who fly 300k airplanes who have had cardiac stents in the past???

14 hours ago, Cruiser said:

Tom, I have to strongly disagree with this statement. 

First, the applicant is presenting themselves with a valid FAA medical that had been previously approved.

I would ask you to think of it this way:
Pilots have an intrinsic right to fly. 
The government has an intrinsic responsibility to keep people safe. 
The government made some medical rules that they think meets the government's obligation to keep people safe. 
The FAA doesn't have physician resources to see every pilot, so they designate physicians as AMEs.
The AME acts as a surrogate on behalf of the government to make sure that the pilot-applicant doesn't have a reason for the government to ground the pilot.
When the AME signs off on the pilot-applicant, s/he is only saying that the government doesn't have evidence to ground the pilot.
Belaboring the point, an FAA medical is not an endorsement of safe or healthy to fly...only verification that the FAA has met it's perceived obligation to keep people safe.

BasicMed is different: it's an endorsement that the pilot is safe.  Moreover it includes an all-inclusive blanket statement by a physician who probably has little knowledge of what is otherwise a specific specialty in the practice of medicine.  Agree with the reality or not, aviation is considered a substantial enough different environment that an entire specialty of medicine exists to serve the "specific" medical needs of people operating in the aviation environment (i.e. stress, oxygen, ~guaranteed death if incapacitated, etc).

14 hours ago, Cruiser said:

Second, the only medical history relevant is that which has occurred since that last valid FAA medical

Let me ask you to think of it this way:
Do you think I'll provide you a medical clearance for major surgery (e.g. hip replacement) because the FAA gave you a 3rd Class 23 months ago and you haven't had any problems since?  That nothing in your medical history from 10 years ago matters?  That the two previous times you had surgery you had a bad reaction to anesthesia and almost died doesn't matter?

14 hours ago, Cruiser said:

Third, you present a SI condition as a cause for denial when if fact the SI is actually an approval by the FAA Medical headquarters

I mean to present the SI as "pick me, pick me" grounds for a lawsuit.
An approved SI issuance means that a team of govt doctors agreed, at the time it was issued, that the information presented to them did not meet govt criteria to ground the pilot.

The government's criteria for grounding is not the same as a plaintiff's criteria for finding physician culpability for signing off as "no condition that could interfere with the ability to operate an aircraft."  An SI highlights that the condition does present a specific and significant risk.  Just that they government can't keep the pilot on the ground because of it.

An SI given 41 months ago is not a clean bill of health today.
I would ask you to think about how difficult it would be to find 5 physicians, cardiologists, or aeromed physicians who would act as a plaintiff's expert witness to testify that they "would not have signed off on that BasicMed form without repeating the same testing required by the FAA and/or the tests that aeromedical physicians would routinely obtain for such a patient."

14 hours ago, Cruiser said:

and Finally, the examining doctor is only certifying that he completed the examination in accordance with the checklist provided by the FAA and that based on that examination he is not AWARE of any medical condition (existing at the time of the exam) could interfere with the individual's ability to safely operate an aircraft.

Ignorance is not a defense in malpractice cases.

Imagine this exchange in court:
Plaintiff's attorney: "Dr. Kidsdoc, you gave the patient medicine X and they had a prolonged seizure that resulted in brain damage, is that correct?"
Dr. Kidsdoc: "yes"
Plaintiff's attorney: "but Dr. Kidsdoc, it is well known that medicine X can cause seizures in adults"
Dr. Kidsdoc: "well, I wasn't aware of that"

Or the following exchange:
Plaintiff's attorney: "Dr. Sawhimonce, you okayed the patient for major surgery but he had a heart attack and died during surgery"
Dr. Sawhimonce:  "yes, I cleared him"
Plaintiff's attorney: "But everyone in the patient's family that ever went to surgery all died on the table"
Dr. Sawhimonce: "I didn't know that...I just saw him once...and besides, the form didn't ask about that"
Plantiff's 5 expert witnesses testimony "I only clear a patient for surgery after obtaining lots of records...if the patient has no records, we do lots of tests, and obviously that information matters"

14 hours ago, Sherman18 said:

Cruiser, you are 100% correct in your statements.  The liability is no more (possibly less) than doing a regular annual exam.  If you get an exam that checks out ok, get in your car, have a massive coronary and die, is the MD that did the exam liable for damages to you or others?  Hardly.  That is life, and no one but God knows when it will end.

Seriously: please explain why dentists send dental patients to their doctor with a form to "clear the patient" before performing a simple dental procedure! 

The next time you receive such a form back, is it okay for the GP to write: "Well Dr. Sherman, I don't know if the patient will have a massive coronary and die or not....God knows when it will end...good luck with the extraction."

13 hours ago, BKlott said:

Thinking back on it now, that was all just plain silly. My family Doctor is the most knowledgeable person with regards to my health. He should be the one to advise me and be part of the decision making process, along with my family, for when my flying days come to an end. I think that is how it should be and that is far more preferable than having some physician in Oklahoma City making that decision for me.

Agreed.

The 3rd class medical system is silly (and the 1st/2nd Class needs reform).  It literally harms pilots (who neglect treatment), family/passengers (who suffer when the pilot's neglected condition causes loss of life, livelihood, or causes an accident), and on occasion people on the ground (societal loss and/or personal injury).

[Roger O]

Tom, we sometimes send our patients to their physician for a medical clearance before procedures to eliminate any obvious health risk, same as the FAA is doing with BasicMed.  It doesn't guarantee anything, it just rules out the obvious.  For example, there are certain types of cardiac valve defects that can cause serious consequences to the patient if they are not given antibiotics prior to the dental procedure.  It is the physician who can perform the necessary testing to determine if this premedication is necessary, not the dentist.  By the way, my name is ROGR (it's my signature beneath the post), my login name is Sherman18.

[Tom]

3 hours ago, Sherman18 said:

For example, there are certain types of cardiac valve defects that can cause serious consequences to the patient if they are not given antibiotics prior to the dental procedure.  It is the physician who can perform the necessary testing to determine if this premedication is necessary, not the dentist. 

The “needs antibiotic prophylaxis or not” and "pre light anesthesia" consults each are algorithms that could basically fit on the front and back of a single piece of paper.

I have three aerospace medicine texts.  The smallest is over 300 pages and the other two are over 700 pages.

18 hours ago, Sherman18 said:

The liability is no more (possibly less) than doing a regular annual exam. 

So you are saying that you consult a physician for questions about antibiotic prophylaxis, but a primary care physician without aviation medicine familiarity is not exposed to extra liability for signing off a physical on a patient with compensated heart failure...a condition that causes them no problems while driving?

19 hours ago, Sherman18 said:

As far as ANY health care practitioner signing off on an exam, that is highly doubtful, and I for one would love to see where it says that.  As a licensed dentist, my state dental practice act only allows me to examine those parts of the body associated with my area of expertise. 

https://www.faa.gov/licenses_certificates/airmen_certification/basic_med/media/basicmed_faq.pdf

Q36:

I don’t have a doctor who is a M.D. (Doctor of Medicine) or D.O. (Doctor of Osteopathy). I do use a chiropractor physician and a naturopathic physician. Can I use them?

A:

The FAA relies on the determination of each state (as well as each territory and possession of the United States) as to which persons it will license as physicians. If the person holds a license as a Physician issued by any state, territory, or possession, then he or she meets the requirement as a state-licensed Physician. However, the FAA recommends that you check with the medical licensing board or authority in your state for clarification as to whether other classes of “state-licensed physicians” are felt to have the privileges, training and experience to conduct all portions of the comprehensive Medical Examination Checklist (CMEC).

[mooniac15u]

I think we've been beaten over the head here with all the hypothetical reasons that no MD will ever sign off a Basic Med.  And yet, in the same thread we have people who are already succeeding...

[carusoam]

’I have three aerospace medicine texts.' - Tom

Want to share?

We have read some pretty technical thesi(s) and books by MooneySpace authors.  

They share, we read.  Everyone gets stronger this way.

Anyone see how long it takes to get a class III med with an SI, through the system lately?

Best regards,

-a-

Edited April 28, 2017 by carusoam